Laserfiche WebLink
!to 0 <br />(b) Is the current certificate orker's compensation insurance on file? YES NO [ ] <br />(c) Does the contractor possess a "Hazardous Substance Removal Certification"? YES NO [ ] <br />(d) Has everyone on site, including crane/ backhoe operator, been certified to work on <br />(e) hazardous waste site in accordance with CCR Title 8? YES NO [ ] <br />2. Has a "Site Health & Safety Plan" for this job site been submitted? XT`fAt,HfLa YESX NO [ ] <br />3. Has applicant performing removal in the City of Tracy obtained a "Grading and Excavation Perm,� <br />N/A [ ] YES [ ] NO [ ] If YES, Permit # At • 7- <br />/!!, ems' S- <br />4. Has the contractor obtained approval from the local fire department to perform tank cutting? NAg YES[ ] NO[ ] <br />*4 -r. #-,�V t 6--r, we, <br />5. Is there knowledge or evidence of leakage from the tank(s) ,and/or piping? (If yes, please explain) YES)4 NO [ ] <br />L. V� c'�e7✓G�= fZb1r{. G/ /7Ow.:�-t �G !�/4Zr.. j fir! %'�.t'.• <br />6. If tank residual exists, identify transporting hazardous waste hauler: <br />NameC� Hauler Registration #-90P,7— 0 <br />Address Z �.S / AC�Q 8�r'1y . City 4(52, `t�nc Zip <br />Phone # (S' O ) Z v? S <br />Decontamination Procedures: <br />a. Will tank(s) and piping be decontaminated prior to removal? YESX NO [ ] <br />b. Identify contractor performing decontamination: <br />Name <br />Address �.s / A2 Q �`' • City G ~ A4&AJ> Zip /0 5Z epO <br />Phone No.( SAO ) 7-5- <br />. / cT, <br />C. Describe method to be used for decontamination: <br />d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br />4 e, Ieuc�c <br />e. Rinsate Hauler and permitted Treatment, Storage & Disposal Facility: �A d <br />Hauler Name d Hauler RegiStp ifpf,70301-7-3 <br />Address Z S"5" 2 � 1�� V-1-2V-1-2City �"� C lvM�i/�" "`Z <br />A it) 5 O � <br />Phone No. ( :r / d 1 �z 35- <br />• / SP -7 <br />Permitted Disposal Site /e oM I C 2,(m ©®q4 5-�X'6 S� <br />EH 23 046 (Revised 10/ 16/03) Page 4 <br />